Technology in Rehabilitation part 2
Previously, I wrote on the Bobath concept, a hands-on problem solving approach neurological rehabilitation and movement re-education. It is not generally supported by randomized control trials, (RCT). But as it is a human-to-human interactive therapy, RCTs are not effective tools to assess its broader effect. New technologies, however, are possible to assess with RCTs. And so, until there are long enough, broad enough, and deep enough trials, we should look to technology with hope but also a bit of skepticism until these treatments are proven, because they can be proven with more traditional research designs and the risks of using certain types of new technologies can be significant.
Some treatments, such as the CCSVI for MS, has now been disproven, where once it was unclear as to whether it worked or not. Other new devices, such as the PoNS are being tested with a variety of individuals and conditions, but as of yet, the PoNS has not been adequately studied to say definitively whether help the stroke victim population, for example.
I have seen disastrous results with one client who tried an ‘as-of-yet’ confirmed technology for their condition who ended up requiring brain surgery after the initial assessment due to developing epilepsy from it – they were not the right candidate and were entered into the program before the item was ready for their condition – and their Life will never be the same.
Perhaps this is why I have spent some time thinking on this topic. I don’t mean to sound negative. The truth is far from it. I am excited by new ways we can help people return to their Lives. I was watching the news recently and there was a piece about how a woman who experiences cognitive processing impairments from a heart attack is handling the changes associated with the Covid-19 pandemic. There were pictures and videos of her before her incident. She was an intelligent and lively human. Behind each case of neurological injury that I see, there is a similar story – someone who went on with their Lives following their passions with the freedom an intact central nervous system affords us. I want nothing more than to be able to help those who have lost that freedom by any available means. I also want to make sure that the products that are coming out and are set to come out for public consumption have been vetted appropriately so we don’t walk blindly into them. My friend and previous client I wrote about above would back me up here.
We look to these new devices and procedures with hope. And we should. But the reality is that once something hits the media, that doesn’t mean it is ready to go for everyone. It just now has a face and a story and so is something we can hear about.
A challenge that faces technological advancement in neurological rehabilitation is the same as in hands-on concepts: people are unique and injuries are unique. So it becomes difficult to generalize to an entire diagnosis or population. For example, with a technology for the stroke population, which type of stroke should be studied to gauge its effects/ where in the brain was the stroke/ does that matter/ how long post stroke/ what age group/ and which pre-stroke health factors would be considered? The answers to these questions could dramatically change the result of any study and are carefully considered. This does potentially slow down the process of licensing any technology for use for an entire population. And that is a good thing. Frustrating as it may be, the consequences of using an unproven technology could be worse than the situation someone is in prior to using it. That, I guess is really the heart of my two posts on this topic thus far. I am excited, but cautiously so. Tempered hopeful expectation.
There will be new technologies coming up that will speed up the process of neuro-plasticity, just as planting a partly grown plant will grow faster than a seedling and different fertilizers help plants to grow faster and stronger.
In looking at technology for use in rehabilitation, we have to understand how it moves in stages. There is the invention stage, the research stage, clinical trials, remodelling and licensing stages for very specific purposes, and then expanding those purposes as applicable once they are licensed. This all takes time.
In the future, perhaps technology will be able to reverse insults to the central nervous system or be able to augment our physical bodies to overcome those insults. At present, we are at the dawn of these miracles. Whether or not they will be miracles has also yet to be uncovered. If they are proven to work, we should embrace these new technologies with open arms for the good they can do to help those in need.
Another aspect of technology that is important to consider is in the biological sciences. That is to say, researchers are still discovering new aspects within our own bodies that may hold some keys for future therapies. Look at KCC2, for example. (KCC2 is a neuron-specific membrane protein expressed throughout the central nervous system, including the hippocampus, hypothalamus, brainstem, and motor neurons of the ventral spinal cord), to quote the internet search engine, and there is much research being done on how this protein may help in reducing spasticity for individuals with spinal cord injuries. They are also looking at new ways to guide neurons’ regrowth along the spinal cord using bio-tech ‘scaffolding’. These are technological feats that were not possible years ago, however many may overlook this technology over the more obvious forms such as robotic limbs, electronic stimulators and computers/apps.
The future of rehabilitation will undoubtedly change in the coming generation. We will have new gadgets for sure, but perhaps some of the biggest changes to come will be aspects of ourselves and our bodies that we have yet to discover.
Technology in rehabilitation will not, however, completely replace the importance of human connection in rehabilitation, nor human intuition and knowledge. I hope that research, clinical practice and the use of technology will become even more intertwined in the coming years. More and more universities and research facilities are coming up with ways to create research – clinical partnerships to help to expedite promising research into the field.
We Live in exciting times, but patience remains our ally.